Professional consensus on UK national statements of best practice for ways of working to deliver orthotic interventions after stroke: an eDelphi study

Authors

  • Miriam Golding-Day Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK https://orcid.org/0000-0002-0700-5395
  • Shirley Thomas Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK
  • Phillip Whitehead School for Business and Society, University of York, York, UK
  • Jane Horne Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK
  • Marion Walker Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK

DOI:

https://doi.org/10.2340/jrm.v58.44360

Keywords:

Stroke Rehabilitation, Orthotics intervention, Professional consensus, Best practice

Abstract

Objective: To reach consensus on statements of best practice for ways of working to deliver orthotic interventions after stroke among expert professionals in the UK involved in the delivery of orthotic intervention to patients after stroke.

Design: A 2-round modified electronic Delphi exercise (eDelphi).

Subjects: Thirty-two orthotic professionals with 2 years’ or more experience of delivering orthotic intervention within stroke rehabilitation, from varied geographical locations and experience levels participated in the eDelphi.

Methods: For the eDelphi exercise, 65 statements of best practice were assessed by participants. A 7-point Likert scale was used to determine agreement with statements. A consensus threshold of 75% was pre-determined in line with other studies.

Results: After the first round, consensus was reached for 62 of the statements. All statements had 75% or above agreement. An 87.5% retention rate was maintained between rounds. After the second round 64 statements of best practice achieved 75% consensus.

Conclusion: Overall consensus 94.3% was achieved on the first UK-wide professionally agreed statements of best practice detailing the optimal ways of working when delivering orthotic interventions to enhance rehabilitation outcomes and reduce complications for stroke survivors.

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References

Stroke Association. State of the nation: stroke statistics; 2018 [cited 2025 Nov 20]. Available from: https://www.stroke.org.uk/stroke/statistics

Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820.

https://doi.org/10.1016/S1474-4422(21)00252-0 DOI: https://doi.org/10.1016/S1474-4422(21)00252-0

Richards CL, Olney SJ. Hemiparetic gait following stroke. Part II: Recovery and physical therapy. Gait Posture 1996; 4: 149–162.

https://doi.org/10.1016/0966-6362(96)01064-8 DOI: https://doi.org/10.1016/0966-6362(96)01064-8

Olney SJ, Richards C. Hemiparetic gait following stroke. Part I: Characteristics. Gait Posture 1996; 4: 136–148.

https://doi.org/10.1016/0966-6362(96)01063-6 DOI: https://doi.org/10.1016/0966-6362(96)01063-6

National Institute for Health and Care Excellence. Stroke rehabilitation in adults: NICE guideline [NG236]; 2023 [cited 2025 Nov 20]. Available from: https://www.nice.org.uk/guidance/ng236

International Organisation for Standardisation. Prosthetics and orthotics Vocabulary (ISO Standard 8549-1: 2020) Part 1: General terms for external limb prostheses and external orthoses; 2020 [cited 2025 Nov 20]. Available from: https://www.iso.org/standard/79495.html

British Association of Prosthetists and Orthotists. Orthotic Treatment: Stroke Rehabilitation; 2014 [cited 2025 Nov 20]. Available from: https://www.bapo.com/wp-content/uploads/2018/01/Stroke-Rehabilitation-Poster-FINAL-.pdf

Down K, Stead A. Assistive technology workforce development; 2007 [cited 2025 Nov 20]. Available from: https://web.archive.org/web/20110107235321/http://www.fastuk.org/fastdocuments/AT_workforce_June2007_v2.pdf

NHS England Workforce, Training and Education. Prsothetics and orthotics; 2019 [cited 2025 Nov 20]. Available from: https://www.hee.nhs.uk/our-work/prosthetics-orthotics

Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke for the UK and Ireland; 2023 [cited 2025 Nov 20]. Available from: www.strokeguideline.org

Condie E, Cambell J, Martina J, editors. Report of a consensus conference on the orthotic management of stroke patients. InReport of a consensus conference on the Orthotic Management of Stroke. International Society for Prosthetics and Orthotics; 2004 [cited 2025 Nov 20]. Available from https://cir.nii.ac.jp/crid/1572824500354286080

Golding-Day M, Young J, Charlton P, Houston B, Thomas S, Walker M. Orthotist involvement in early gait rehabilitation following stroke: a cross sectional survey of orthotists in the United Kingdom. Prosthet Orthot Int 2025; 49: 298–305.

https://doi.org/10.1097/PXR.0000000000000365 DOI: https://doi.org/10.1097/PXR.0000000000000365

Johnston TE, Keller S, Denzer-Weiler C, Brown L. A clinical practice guideline for the use of ankle–foot orthoses and functional electrical stimulation post-stroke. J Neurol Phys Ther 2021; 45: 112–196.

https://doi.org/10.1097/NPT.0000000000000347 DOI: https://doi.org/10.1097/NPT.0000000000000347

Australian Orthotic Prosthetic Association. The role of the orthotist in the management of stroke: providing ankle–foot orthoses to improve walking and balance in stroke survivors; 2016 [cited 2025 Nov 20]. Available from: https://www.aopa.org.au/documents/item/530

Bowers R, Ross K. Best Practice Statement: Use of ankle–foot orthoses following stroke. NHS Quality Improvement Scotland; 2009 [cited 2025 Nov 20]. Available from: https://strathprints.strath.ac.uk/16846/

Golding-Day M, Prince N, Thomas S, Horne J, Thomas L, Walker M. Early specialist orthotic interventions for the lower limb in adult stroke patients: a systematic literature review. J Int Foot Ankle Foundation 2022; 1.

https://doi.org/10.55067/jifaf.v1i9.27 DOI: https://doi.org/10.55067/jifaf.v1i9.27

Golding-Day MR, Whitehead PJ, Walker MF. Orthotic -intervention following stroke: a survey of physiotherapist, occupational therapist and orthotist practice and views in the UK. Int J Ther Rehabil 2022; 29: 1–6.

https://doi.org/10.12968/ijtr.2021.0177 DOI: https://doi.org/10.12968/ijtr.2021.0177

Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and Reporting Delphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 2017; 31: 684-706.

https://doi.org/10.1177/0269216317690685 DOI: https://doi.org/10.1177/0269216317690685

Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014; 67: 401-309.

https://doi.org/10.1016/j.jclinepi.2013.12.002 DOI: https://doi.org/10.1016/j.jclinepi.2013.12.002

Salant P, Dillman D. How to conduct your own survey. Chichester: Wiley; 1994.

https://doi.org.10.2307/3152021

Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol 2021; 11: 116.

https://doi.org/10.5662/wjm.v11.i4.116 DOI: https://doi.org/10.5662/wjm.v11.i4.116

Duncan EAS, Nicol MM, Ager A. Factors that constitute a good cognitive behavioural treatment manual: a Delphi study. Behav Cogn Psychother 2004; 32: 199-213.

https://doi.org/10.1017/S135246580400116X DOI: https://doi.org/10.1017/S135246580400116X

Atkins S, Odendaal W, Leon N, Lutge E, Lewin S. Qualitative process evaluation for complex interventions. In: Complex interventions in health: an overview of research methods. London: Routledge; 2015. p. 239-247.

https://doi.org/10.4324/9781003495642 DOI: https://doi.org/10.4324/9781003495642

Bradford B. The Delphi method: a useful tool for the allied health researcher. Br J Ther Rehabil 1996; 3: 677-681.

https://doi.org/10.12968/bjtr.1996.3.12.14731 DOI: https://doi.org/10.12968/bjtr.1996.3.12.14731

Mullen PM. Delphi: Myths and reality. J Health Organ Manag 2003; 17: 37-52.

https://doi.org/10.1108/14777260310469319 DOI: https://doi.org/10.1108/14777260310469319

Farmer T, Robinson K, Elliott SJ, Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qual Health res 2006; 16: 377-394.

https://doi.org/10.1177/1049732305285708 DOI: https://doi.org/10.1177/1049732305285708

Silvola S, Restelli U, Bonfanti M, Croce D. Co-design as enabling factor for patient-centred healthcare: a bibliometric literature review. ClinicoEconom Outcomes Res 2023: 333-347.

https://doi.org/10.2147/CEOR.S403243 DOI: https://doi.org/10.2147/CEOR.S403243

Online surveys. 2025 [cited 2025 May 31]. Available from: https://www.onlinesurveys.ac.uk/

Likert R. A technique for the measurement of attitudes. Arch Psychol 1932; 140: 1-55.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.

https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Health & Care Professions Council. Resources. HCPC -Registrant snapshot - 1 March 2023 [cited 2025 Nov 20]. Available from: https://www.hcpc-uk.org/resources/data/2023/registrant-snapshot-march-2023/

Health & Care Professions Council. HCPC Diversity Data Report 2021: prosthetists /orthotists. 2021; 1-7 [cited 2025 Nov 20]. Available from: https://www.hcpc-uk.org/globalassets/resources/factsheets/hcpc-diversity-data-2021-factsheet--prosthetists---orthotists.pdf

Baker J, Lovell K, Harris N. How expert are the experts? An exploration of the concept of ’expert’ within Delphi panel techniques. Nurse Res 2006; 14: 59-70.

https://doi.org/10.7748/nr2006.10.14.1.59.c6010 DOI: https://doi.org/10.7748/nr2006.10.14.1.59.c6010

Eddison N, Healy A, Leone E, Jackson C, Pluckrose B, Chockalingam N. The UK prosthetic and orthotic workforce: current status and implications for the future. Hum Res Health 2024; 22: 3.

https://doi.org/10.1186/s12960-023-00882-w DOI: https://doi.org/10.1186/s12960-023-00882-w

Bernhardt J, Borschmann K, Boyd L, Carmichael ST, Corbett D, Cramer SC, et al. Moving rehabilitation research forward: developing consensus statements for rehabilitation and recovery research. Int J Stroke 2016; 11: 454-458.

https://doi.org/10.1177/1747493016643851 DOI: https://doi.org/10.1177/1747493016643851

Bernhardt J, Hayward KS, Dancause N, Lannin NA, Ward NS, Nudo RJ, et al. A stroke recovery trial development framework: consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14: 792-802.

https://doi.org/10.1177/1747493019879657 DOI: https://doi.org/10.1177/1747493019879657

Walker MF, Hoffmann TC, Brady MC, Dean CM, Eng JJ, Farrin AJ, et al. Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2017; 12: 472-479.

https://doi.org/10.1177/1747493017711815 DOI: https://doi.org/10.1177/1747493017711815

Additional Files

Published

2026-03-04

How to Cite

Golding-Day, M., Thomas, S., Whitehead, P., Horne, J., & Walker, M. (2026). Professional consensus on UK national statements of best practice for ways of working to deliver orthotic interventions after stroke: an eDelphi study. Journal of Rehabilitation Medicine, 58, jrm44360. https://doi.org/10.2340/jrm.v58.44360

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